“Old Dog” Vestibular Disease

I don’t get to give a lot of good news to my clients. As some of you already know, my veterinary practice deals primarily with end-of-life issues – hospice and in-home euthanasia mostly – not an environment where good news abounds. So, when I see a consultation appointment scheduled for an older dog whose owner is describing a head tilt, difficulty walking and eyes that are “moving funny,” I get really excited.

Why? Because these are symptoms of a condition that looks really, really bad (owners often think their dogs have had strokes), but usually gets better on its own with little or no treatment. Veterinarians don’t know exactly what causes idiopathic vestibular disease (“idiopathic” means arising from an unknown cause, or the pathologist is an idiot, as one of my professors said in veterinary school), but it is very common.

The vestibular system is composed of portions of the brain and ear and is responsible for maintaining our sense of balance. When something goes wrong with the vestibular system, it feels like the world is spinning.

Dogs with idiopathic vestibular disease have some combination of the following symptoms:

A head tilt

They are unsteady on their feet and may fall over

They circle in one direction or even roll across the floor

Their eyes flick back and forth, up and down, or rotate in a circle (this is called nystagmus)

An eyes flick back and forth due to nausea

Vomiting

These clinical signs are not unique to idiopathic vestibular disease. Infections, tumors, inflammatory diseases and other conditions can all adversely affect a dog’s vestibular system, so a thorough physical exam is necessary. But when the symptoms seemingly appear out of nowhere in an older dog and then start to improve over the course of a few days to weeks, idiopathic vestibular disease is usually the cause.

When I suspect that one of my patients is suffering from idiopathic vestibular disease, I generally recommend a wait and see approach and treat symptomatically. For example, owners need to protect the dog from falls, help him outside to urinate and defecate, and hand feed and water if necessary. Sometimes I’ll prescribe anti-nausea medications. If the dog starts to get better in a few days and is more or less back to normal in a few weeks, additional diagnostic testing is not necessary. If that is not the case, or if the initial physical exam is not fully supportive of idiopathic vestibular disease, blood work, X-rays, CT scans, MRIs, and other tests may be necessary to reach a definitive diagnosis.

Most dogs with idiopathic vestibular disease recover fully. Others have mild but persistent neurologic deficits (e.g., they have a head tilt or wobble a bit when they shake their heads), but these are rarely serious enough to adversely affect their quality of life. Dogs can have more than one bout of idiopathic vestibular disease as the age, but since the symptoms look familiar to owners, they usually don’t panic the second or third time around.

Idiopathic vestibular disease isn’t always benign. I’ve had a few cases where we’ve had to euthanize because dogs have been severely affected and have failed to recover sufficiently, but these are the exception rather than the rule. So, if your dog has been diagnosed with idiopathic vestibular disease, take heart; there is every reason to be optimistic.

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